The argument that teamwork is essential to the effective delivery of healthcare is undisputed. In 1999, Risser and colleagues demonstrated that teamwork breakdowns in the emergency department (ED) were a critical root cause of sentinel events at eight hospitals costing the hospital approximately $3.50 per ED visit. Mann, Marcus, and Sachs (2006) found that team training reduced the number of claims made against the OBGYN service at Beth Israel Deaconess Medical Center by 50% over a 3-year period. Arguably team training has tremendous potential as a risk mitigation and liability reduction strategy. To address this vital need, AHRQ released TeamSTEPPSTM (Team Strategies and Tools to Enhance Performance and Patient Safety). A prevailing strategy for reducing liability claims is full disclosure. Research has shown that when physicians disclose their mistakes payouts for claims against the doctor and the hospital are reduced. Similarly, a central tenant of TeamSTEPPS is that the patient and the patient's family members are important members of the team;communication among providers, patients, and patient families is critical. Therefore, it is important to understand how to include patients and patient families in the care team, how to equip patients and patient families to be effective team members, and how to communicate with patients about the risks and mistakes that can occur throughout the care process. Inclusion of patients and patient family members in the care team and preparation through team training should yield better communication among providers, patients, and patient families and as a result mitigate risk and reduce liability claims. However, research must specify how to include patients and their family members as part of the care team, how to train patients and their family members to be effective team members, when this training should occur, and what would be the result. To address this need, we propose to identify four adverse outcomes that vary in terms of risk and liability;develop risk models that capture the system, individual, and team factors associated with each outcome;identify TeamSTEPPS interventions that can be taught to providers, patients, and families to reduce the risk associated with each outcome and improve provider-patient-patient family communication;and pilot test our intervention in obstetrics. Positive results from this project will lead to wide scale implementation of our intervention within Carilion Clinic. We will also track risk and liability data to demonstrate the effectiveness of our approach. PUBLIC HEALTH RELEVANCE: This project examines how improved teamwork, through better communication among providers, patients and patient families, can mitigate risk and reduce liability claims in order to improve quality of care and patient safety.